The focus of this call was to review our progress report and to review the final work plan. A summary of points covered is reviewed below.

Progress Report

Task 4

OMB clearance not needed for focus groups.

Identified target meeting for focus group at the Academic Surgical Congress in February 2010.

Task 2

Mapping ICD-9 codes to CPT codes—Mike and Makoto are continuing to work on the mapping

CDC would like to see the mapping when available.

Task 1

Monthly conference calls are set-up for the third Tuesday of every month at 12:00 MST (Next call 15 December).

First face-to-face meeting is scheduled for Friday, 20 November at IH.

Subcontracts with organizations are progressing.

Work Plan

Resolution matrix was included in the updated work plan to clearly specify how the research team addressed the comments and recommendations from the CDC technical experts and AHRQ TOO.

Connie Price explained the rationale for covering herniorrhaphy (HER) over colon surgery because HER is more elective and allows for more pre-op opportunity to modify SSI risk; and many states, including Colorado, are reporting SSI cases for herniorrhaphy; further, it allows us to examine a relatively common and often outpatient surgery.

Sandra Barrios questioned the timing of the focus groups and validating the risk factors.

Lucy will revise the work plan to clarify the timing and relationship of the tasks.

Next meeting: 15 December 2009, 12:00 MST

Monthly Teleconference
Tuesday, 15 December 2009; 12:00 MST

Clarification of the list of risk factors

The list should include all risk factors—modifiable and non-modifiable

Overall Project Status update

Task 2

Review of ICD-9 and CPT codes to complete mapping.

In the process of forming a data dictionary.

Working with Scott Evans to identify data elements from IH algorithm.

SLCVAH has received approval from the VA security officer to participate as planned.

Task 3

A timeline is being created and reviewed to facilitate the steps necessary leading-up to the focus groups.

In review of the initial list of risk facts from Walt Biffl, Scott Evans has added an "EMR" column to indicate of it is currently available in the EMR; and he has added a �Define� column to indicate the need to clarify the definition of the risk factor.

Literature search from 2008 - current was conducted-

PubMed keyword search: "SSI risk factors"

Scott is compiling a list of additional risk factors based on a review of abstracts defining and listing SSI risk factors.

Task 4

Walt Biffl is planning the focus group to include 10-12 surgeons at the Academic Surgical Congress, in February.

The focus group will review current accepted risk stratification models and review the list of new risk factors.

The group will evaluation additional risk factors not in the list and provide feedback relevant to the factors being modifiable vs. non- modifiable.

Task 1/5

During the meeting at IH, the group review and coordinated the responsibilities across the organizations.

Action item

The CDC/AHRQ team requested a contact list of individuals involved in the project.

Susan and Jason will coordinate and distribute the complete list to the CDC/AHRQ team.

The CDC/AHRQ team had concerns regarding the algorithm being driven off of positive cultures.

The plan is to progress with the current algorithm for a test set then review the gaps and look at other work to pick-up any events initially missed.

Task 3

The list of identified risk factors is to include all factors-including modifiable/non modifiable, measurable/non measurable; and will begin review by each organization to determine availability in EMR

Each organization is beginning review of the list of risk factors and will have EMR availability results to the group by 5 February 2010.

Task 4

A room for the focus group has been reserved and 4 participants are currently confirmed

The CDC/AHRQ team requested a list of specialties of the focus group participants

Once all participants for the focus group have been confirmed, Susan will compile and submit this information.

Susan and Lucy are preparing a guide for the focus group.

A focus group of OR nurses is being planned at Intermountain Healthcare.

Plan is submitted for expedited IRB review.

Task 1/5 � Administrative

Subcontract between Denver Health and SLCVAH is complete.

Subcontract between Denver Health and Intermountain Healthcare is near complete.

Intermountain Healthcare is working to get Privacy Board approval for use of de-identified data.

SLCVAH has received Privacy Board approval for use of de-identified data.

Next scheduled call: 16 February 2010 - 14:00 EST; 12:00 MST*agenda and any reference materials will be sent on 12 February 2010 due to Presidents� Day holiday on 15 February 2010

The rigor of the surveillance with NSQIP is more complete than the collection at most sites.

Tested at SLCVAMC and Intermountain

Intermountain only collects on one procedure

Options

Use national VA data

Not diverse population

Difficult to get permission to use national data

Use of VA NSQIP and IH data

Any concerns with using IP collected data

If the algorithm is being designed to replace the typical IP system, it should be to base it off of typical IP collection.

It can be validated against the different systems and verify against NSQIP (SLCVAMC) and Intermountain.

Subset analysis of perioperative deep wound/organ space infections

Task 3

Review of data collection process for common risk factors

IH has reviewed all common risk factors and identified several elements that could be problematic to collect reliably.

IH has completed provisional analyses of ~ 20,000 patients

Denver has begun collection of data and will report with any trouble elements.

Outstanding items discussion

Postop hemoglobin has been added to the risk factor list

Abx dx - 48 for CABG, and 24 for all others

need to add into risk factors table

Hypocholesterolemia "TYPO? Instead of Hyper?"

Hypocholesterolemia was determined as a risk factor by the surgeon focus group as an indication of poor wound healing

Anemia-follow-up on collection of value-the collection of the value is possible instead of just a yes/no.

Task 4

Final content analysis of surgeon focus group

The usefulness of the focus group outcomes:

The process of the focus group can be considered and discussed in the final report

Validity check

Engaging the surgeon group

Capturing factors the team may not have considered.

Task 1/5

Administrative

IRB & Privacy Board approval pending at Denver and Intermountain

Additional items, questions/concerns, or comments.

Next call:
17 August 2010; 14:00 EST; 12:00 MST
*agenda and reference materials will be sent on 13 August 2010--There may be a potential conflict with this call.Sandra and Teresa will check their schedules and contact Susan to reschedule if necessary

Currently working to get the data into a usable format for the algorithm

Task 3

Program development and data analysis at Intermountain

The program is being developed using Intermountain and Denver Health data

The program will be updated as data from other sites come in

Vail is expecting to have data available early January

SLC VA is working to finish collection

Development of table to indicate where each system had the data for each risk factor.

The process of data collection is being carefully documented to identify data sources as well as the decision making process to use one data source over another

There have been no surprises from the data collection process except for the varied sources of data—which, as indicated, are being thoroughly documented.

Task 4

Repurposed nursing focus group to present use cases for response.

First focus group will assess and develop workflow of current SSI surveillance and the resources for process change implementation

A mockup flowchart will be presented for the group to respond to.

Second focus group will assess workflow from first group and address the resources and workflow for process change implementation.

Both focus groups are planned to be held in January

Denver (Mile High APIC)

Salt Lake City

Generalizability of results

The focus groups are expected to have representation from at least 6 different systems

The groups will be looking at the process of an electronic surveillance tool

The focus groups are expected to raise some interesting and useful questions about the adoption and use of the surveillance tool as well as process challenges

Updates on conference presentations

SHEA abstract was accepted

Abstract submitted to SIS

Susan will send both abstracts to AHRQ & CDC

Task 1/5

The request has been submitted to the contracting officer to pay for dissemination including all costs associated with conference registrations, travel to conferences, journal submissions (e-journal: Implementation Science)

The request was made to pay for such dissemination efforts prior to the end of the contract period.

Final in-person team meeting scheduled for 27-28 January 2011 in Vail, Colorado as a writing retreat for the draft final report.

Jonathan expressed interest in attending the meeting

Susan will look into reserving a room at the hotel for him and confirm with him in early January

Draft final report will be submitted to AHRQ by 11 February 2011

The report has been outlined and sections have been assigned.

Sections will be completed mid-January

The sections will be integrated to be worked on at the January 27-28 meeting

A �Lessons Learned� section will be included in the report

Final report will be submitted to AHRQ 11 March 2011

Next call:
18 January 2011; 14:00 EST; 12:00 MST*agenda and reference materials will be sent on 14 January 2011

The CDC/AHRQ team had concerns regarding the algorithm being driven off of positive cultures.

The plan is to progress with the current algorithm for a test set then review the gaps and look at other work to pick-up any events initially missed.

Task 3

The list of identified risk factors is to include all factors—including modifiable/non modifiable, measurable/non measurable; and will begin review by each organization to determine availability in EMR

Each organization is beginning review of the list of risk factors and will have EMR availability results to the group by 5 February 2010.

Task 4

A room for the focus group has been reserved and 4 participants are currently confirmed

The CDC/AHRQ team requested a list of specialties of the focus group participants

Once all participants for the focus group have been confirmed, Susan will compile and submit this information.

Susan and Lucy are preparing a guide for the focus group

A focus group of OR nurses is being planned at Intermountain Healthcare

Plan is submitted for expedited IRB review

Task 1/5 - Administrative

Subcontract between Denver Health and SLCVAH is complete.

Subcontract between Denver Health and Intermountain Healthcare is near complete.

Intermountain Healthcare is working to get Privacy Board approval for use of de-identified data.

SLCVAH has received Privacy Board approval for use of de-identified data.

Next scheduled call: 16 February 2010 - 14:00 EST; 12:00 MST*agenda and any reference materials will be sent on 12 February 2010 due to Presidents' Day holiday on 15 February 2010

It was proposed to focus the algorithm on deep tissue and organ space infection to increase the sensitivity and minimize false positives of the surveillance tool.

The algorithm is still expected to pick up some superficial infections, but the tool would be honed to pick up the more clinically relevant complex infections.

Sandra asked if CABG is divided into sternal and harvest subgroups as superficial infections are more common in harvest procedures.

The data will be evaluated to look at sternal vs harvest CABG.

Sandra asked if burden estimates can be evaluated to look at the algorithm with all SSI inclusions vs just complex

We need to document what is lost by tuning the algorithm to deep wound and organ space infections

Estimates will be evaluated and included in the final report.

Kendall asked for a flowchart of the algorithm

Mike and Makoto will provide the flowchart, which is generated via the classification tree, and these will be included in the final report as an appendix

Determination of burden to implement the algorithm at different sites

Each site is documenting the set up and implementation process costs.

We expect these to be minimal.

Task 3

The data from all systems is being incorporated and used to identify key risk factors.

Task 4

Repurposed nursing focus group to present use cases for response.

Focus groups have been exempted by the Intermountain IRB and from OMB clearance review (as the two nursing focus group protocols are distinct and in compliance with OMB rules).

Denver—Wednesday, 2 February 2011

Getting ICPs from at least 4 systems in the area to explore issues around adoption of the surveillance tool

Salt Lake City--TBD

ICPs for multiple systems will explore issues around implementation of the surveillance tool

Lucy is working to recruit participants for the 2nd focus group, which is intended to iteratively follow focus group 1 (results from group 1 inform discussion in group 2)

The outputs of the focus groups will be used to create a user manual and include at least 2 use cases.

Task 5

Draft final report will be delivered electronically by 11 February 2011

The report will be in Word format and the appendices will be PDFs

The draft report will also be submitted through ARRS

Updates on conference presentations/dissemination.

Kendall submitted a dissemination plan to include attendance and presentation at SHEA, SIS, Academy Health, and the AHRQ Annual Meeting. Publications were also included in the plan.

Discussion of sustained tool implementation and development

Sandra discussed the importance of making sure the tool is viewed by adopting systems to be dynamic (vs. static)) continually evolving and will QI/QA with continuing feedback to support improvement and continued applicability of the tool.

Kendall asked how we plan to keep a feedback loop.

Feedback recommendations will be made in the report

Denver Health is planning to use the tool and modify it to include other surgeries.

Adoption at SLC VAMC would likely show applicability in VAs nationwide�Mike will explore a connection with the VA National Center for Patient Safety as suggested by Kendalll

Lucy will connect with the AHRQ Health Care Innovations Exchange to explore how we might monitor and track uptake.

Task 1

The call scheduled on 15 February 2011 was proposed to be postponed one week to allow time for AHRQ & CDC to provide feedback from the draft report

Susan will poll the group to reschedule the call

Invoicing

Systems are working with their accounting departments for updated invoices and final invoicing to be submitted on time.

Next call: To be determined, on or about 2/22/11. Susan will get dates and times to reschedule